Banding of oesophageal varices (Endoscopic variceal band ligation (oesophageal varices))
A procedure done during a gastroscopy to place small rubber bands around swollen veins in the gullet, to stop them bleeding or to reduce the risk of a serious bleed.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Banding places small rubber bands around swollen veins in the gullet to stop them bleeding or to lower the risk of a serious bleed.
- It treats the varices but not the underlying liver disease or raised vein pressure, so varices can return and repeat sessions are usually needed.
- It is carried out during a gastroscopy, usually with sedation; an active bleed is an emergency and is often managed in hospital, sometimes with an anaesthetist.
- After banding, ulcers form where the bands were, so a soft diet and acid-reducing medicines are usual, and there is a small risk of bleeding in the following days.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can stop a bleeding varix and is a mainstay of emergency treatment for variceal bleeding
Banding alone is not enough to manage the underlying liver disease and portal hypertension, which need their own treatment.
You rest while any sedation wears off. A clip monitors your oxygen and pulse. You may have a sore throat and some chest discomfort, and you stay until the...
Clear written warning signs of a bleed (vomiting blood, black stools, faintness) and exactly what to do.
You rest while any sedation wears off. A clip monitors your oxygen and pulse. You may have a sore throat and some...
A soft diet is usually advised, and you avoid hot, sharp or hard foods that could irritate the banding sites. If...
The banded veins shrink and separate, and the small ulcers heal. Some chest discomfort and mild difficulty...
Further banding sessions are usually arranged every few weeks until the varices are obliterated, often alongside...
What is banding of oesophageal varices?
Oesophageal varices are swollen veins in the wall of the gullet (oesophagus). They develop when blood flow through the liver is restricted — most often because of scarring of the liver (cirrhosis) and raised pressure in the veins that drain into it (portal hypertension). Like varicose veins in the legs, these vessels can become fragile, and they can bleed, sometimes heavily and dangerously.
Banding is a treatment carried out during a gastroscopy. A small attachment on the end of the camera uses suction to draw each varix into a cap, and a tiny rubber band is released around its base. This squeezes the vein, a clot forms, and over the following days the banded tissue shrinks and falls away, leaving a small ulcer that heals. Banding is used both to stop a vein that is actively bleeding and, in a planned way, to reduce the risk of a first or further bleed.
Banding treats the varices but not the underlying liver problem or portal hypertension, so the veins can come back. For this reason it is usually done as a course of several sessions, a few weeks apart, until the varices are obliterated, followed by regular check-up gastroscopies. It is often combined with medicines that lower the pressure in the veins. Your team should explain how banding fits into managing your liver condition overall.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Emergency banding for active bleeding
Done urgently when varices are bleeding, to control the bleed. Usually part of hospital treatment that also includes drips, medicines and sometimes a blood transfusion.
Primary prevention (varices that have not bled)
Planned banding to reduce the risk of a first bleed in people found to have varices at higher risk, sometimes as an alternative to, or alongside, medicines that lower vein...
Secondary prevention (after a bleed)
A course of banding after a variceal bleed, repeated every few weeks until the varices are obliterated, to reduce the chance of bleeding again.
Surveillance and repeat banding
Follow-up gastroscopies to check whether varices have recurred, with further banding if needed.
Preparing for your procedure
- For a planned procedure, follow the unit's fasting instructions — usually no food for about six hours and only sips of water up to a couple of hours before.
- Tell the team about all your medicines, especially blood thinners, and ask which to stop or adjust and when.
- Mention your liver condition and any previous variceal bleeds, banding or other treatments.
- Discuss sedation and arrange for a responsible adult to take you home and stay with you afterwards.
- Mention any heart, lung or kidney problems, sleep apnoea or reactions to sedation, as these affect monitoring.
- Ask about acid-reducing medication, which is usually given to help the banding ulcers heal.
- Plan for soft foods at home for the first day or two, and know the warning signs of a bleed before you leave.
- If you are admitted with an active bleed, the team will prepare you urgently and explain what is happening.
What happens
Banding is carried out during a gastroscopy. After your details and consent are checked, you usually have sedation through a small cannula in your arm, or sometimes a numbing throat spray. You lie on your left side, a mouth guard protects your teeth and the camera, and a clip on your finger monitors your pulse and oxygen.
The endoscopist passes the flexible camera through your mouth and down into the gullet to find the varices. A banding attachment on the tip of the camera uses gentle suction to draw each varix into a small cap, and a rubber band is released around its base to squeeze it shut. Several bands are usually placed in one session. You may feel some pressure or the sensation of swallowing, but it is not usually painful.
A planned procedure usually takes about 15–30 minutes. Afterwards you rest while any sedation wears off. The banded veins clot and, over the next few days, the tissue shrinks and separates, leaving small ulcers that heal over a week or two. For an active bleed, banding is part of wider emergency care, and you are usually admitted for monitoring. Because varices can recur, banding is normally repeated over several sessions until they are obliterated.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Banding alone is not enough to manage the underlying liver disease and portal hypertension, which need their own treatment.
- It may not be the right option for varices in the stomach (gastric varices), which are often treated differently.
- People who are too unstable for the procedure may need other emergency measures first to control bleeding.
- It does not remove the future risk of bleeding on its own, so it is not a substitute for medicines and follow-up.
Delay or rearrange if…
- For a planned procedure, you have not been able to fast properly.
- Your blood thinners have not been planned around the procedure.
- You have an active infection or are acutely unwell, unless the procedure is urgent for bleeding.
- You cannot arrange a responsible adult to take you home after sedation for a planned session.
- An emergency bleed, by contrast, is treated urgently rather than delayed.
Alternatives to discuss
- Medicines that lower vein pressure, such as beta-blockers, sometimes used instead of or alongside banding for prevention.
- Other endoscopic treatments, such as injection (sclerotherapy) or glue for certain varices.
- Procedures to lower portal pressure, such as a shunt (TIPS), in selected cases when banding and medicines are not enough.
- Treating the underlying liver disease, which is central to reducing the risk over time.
- Emergency measures, including drips, medicines, blood products and sometimes a temporary balloon, to control an active bleed.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can stop a bleeding varix and is a mainstay of emergency treatment for variceal bleeding
- Reduces the risk of a first or further bleed when done in a planned way
- Is generally preferred to older injection treatments, with fewer complications
- Can be repeated over several sessions to obliterate the varices
- Works alongside medicines that lower vein pressure as part of managing the liver condition
Risks & complications
- A sore throat, or chest discomfort and a feeling of something stuck, for a day or two after banding
- Mild difficulty or discomfort swallowing as the banding ulcers form
- Bloating or wind from the air used during the test
- Feeling tired or groggy for the rest of the day after sedation
- Bleeding from the ulcers that form where the bands were, usually in the first days to two weeks
- A band coming off early, sometimes needing repeat treatment
- Breathing, heart-rate or blood-pressure effects from sedation that need monitoring
- Difficulty swallowing that lasts longer than expected
- A narrowing (stricture) of the gullet, more likely after repeated banding of large varices, which may need stretching
- A tear (perforation) of the gullet, which can need urgent treatment or an operation
- Significant bleeding needing further treatment, admission or a transfusion
- A serious reaction to sedation, or breathing stomach contents into the lungs
- Very rarely, the gullet becoming blocked by a displaced band or ulcer
Banding is an effective treatment, but it sits in the context of serious liver disease, which carries its own risks. The most important specific risk is bleeding from the ulcers that form where the bands were, usually in the first one to two weeks — which is why acid-reducing medicines, a soft diet and clear warning-sign advice matter. Repeated banding of large varices can also narrow the gullet. Because banding does not treat the underlying liver problem, the veins can come back, so a planned course and follow-up are important. Ask how many sessions you are likely to need, what to do if you vomit blood or pass black stools, and how your liver condition is being managed overall.
Published figures to discuss
Banding is effective and is generally preferred to older injection treatments because it controls bleeding with fewer complications, but it takes place against the background of serious liver disease, which itself carries significant risk. The chance of a complication depends on whether the procedure is planned or for an active bleed, the size and number of varices, and the person's overall condition. Many published figures come from individual studies and units; the ranges below are cautious and source-defensible rather than exact, and the risks from the underlying liver disease are often greater than those of the banding itself.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Perforation or significant bleeding from the gastroscopy itself | Rare — one NHS unit quotes around 1 in 10,000 for the gastroscopy | This is the risk of the camera test; the specific risk of bleeding from the banding ulcers is separate and occurs mainly in the first one to two weeks. | Cambridge University Hospitals — Gastroscopy with oesophageal variceal banding or injectioncuh.nhs.ukPublished figure |
| Bleeding from banding ulcers | A recognised risk in the days to about two weeks after banding | Acid-reducing medicines and a soft diet are used to reduce it; vomiting blood or black stools needs emergency help. Exact rates vary by study and patient. | Cochrane review — Band ligation for primary prevention of variceal bleeding in cirrhosis (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
| Oesophageal narrowing (stricture) | Uncommon; more likely after repeated banding of large varices | May cause difficulty swallowing and sometimes needs stretching (dilatation). | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
After a planned procedure, most people feel back to near normal within a day or two, though the throat and chest can feel uncomfortable as the banding ulcers form. If you were admitted with a bleed, recovery is longer and depends on your overall condition. The key things afterwards are eating softly at first, taking acid-reducing medicines, and watching for signs of bleeding.
- A sore throat and some chest discomfort for a day or two
- Mild difficulty or discomfort swallowing as the ulcers form and heal
- Bloating or wind that eases as trapped air passes
- Feeling tired for the rest of the day after sedation
- Needing a soft diet at first and acid-reducing medicines to help healing
- Knowing that further banding sessions will usually be needed
Aftercare
- Eat a soft diet at first and avoid hot, sharp or hard foods that could irritate the banding sites, as your team advises.
- Take acid-reducing medicines as prescribed to help the ulcers heal.
- Take any vein-pressure medicines, such as a beta-blocker, exactly as directed.
- If you had sedation, have a responsible adult with you and do not drive, drink alcohol or make important decisions for 24 hours.
- Restart blood thinners only when your team tells you it is safe.
- Attend the planned repeat banding sessions and follow-up gastroscopies, as varices can recur.
- Keep the unit's contact number to hand and know the warning signs of a bleed.
- Follow the wider advice for your liver condition, including any guidance on alcohol and medicines.
- Fasting instructions understood for a planned procedure
- Blood thinners discussed and a plan agreed
- Sedation arranged with a responsible adult to take you home and stay
- Acid-reducing medication arranged to help ulcers heal
- A soft-diet plan for the first day or two
- Warning signs of a bleed clearly understood
- The unit's emergency contact number saved
- The next banding session and follow-up plan known
⚠ Get urgent help if…
- Vomiting blood, or bringing up material that looks like coffee grounds
- Black, tarry or bloody stools
- Feeling faint, dizzy or very weak, or collapsing
- Severe or worsening chest, throat or tummy pain
- Difficulty breathing, or new shortness of breath
- Difficulty swallowing your own saliva, or food sticking
- A high temperature, chills or feeling very unwell
- Any of these — seek emergency help immediately, as a variceal bleed can be life-threatening
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
When banding works well, an actively bleeding varix is brought under control, or the risk of bleeding is reduced. Over a course of sessions, the varices are gradually obliterated, and follow-up gastroscopies check whether they recur. Banding is generally preferred to older injection treatments because it controls bleeding effectively with fewer complications.
It is important to be realistic: banding treats the varices, not the underlying liver disease or raised vein pressure, so varices can come back and further treatment is often needed. It does not, on its own, cure cirrhosis or remove the risk of future bleeds, which is why it is combined with medicines and regular follow-up. Your team should explain what banding can achieve for you and how it fits into managing your liver condition.
Banding obliterates the varices that are treated, but because the underlying portal hypertension continues, new or recurrent varices can develop over time. This is why a planned course of banding, regular surveillance gastroscopies, and vein-pressure medicines are used together. How long the benefit lasts depends largely on the underlying liver condition and how well it is managed.
Related tests, treatments or support
Banding is usually part of a wider plan for liver disease and portal hypertension. It is often combined with medicines (such as beta-blockers) that lower vein pressure, and it follows on from a gastroscopy that identified the varices. People may also have blood tests, scans of the liver, and treatment of the underlying liver condition. In some cases, if banding and medicines are not enough, other procedures to lower vein pressure are considered. Your team should explain how these fit together.
Follow-up & long-term care
After a planned procedure, you are usually told how the banding went on the day. A course of repeat banding is normally arranged every few weeks until the varices are obliterated, followed by surveillance gastroscopies to check for recurrence. You should be told clearly when your next session is, who to contact, and exactly what to do if you have any warning signs of bleeding, which can be an emergency.
- Attend all planned banding sessions until the varices are obliterated.
- Take vein-pressure medicines, such as a beta-blocker, and acid-reducing medicines as prescribed.
- Attend surveillance gastroscopies to check for recurrent varices.
- Follow the wider plan for your liver condition, including advice on alcohol and medicines.
- Report any signs of bleeding promptly, as a variceal bleed can be life-threatening.
- Keep up with blood tests, scans and clinic reviews as advised.
Repeat, follow-on and what comes next
- Banding is normally repeated over several sessions until the varices are obliterated.
- Varices can recur because the underlying portal hypertension continues, so surveillance and further banding are common.
- A band that comes off early, or continued bleeding, may need repeat treatment.
- If banding and medicines are not enough, other procedures to lower vein pressure may be considered.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written warning signs of a bleed (vomiting blood, black stools, faintness) and exactly what to do.
- Acid-reducing medicines and soft-diet advice to help the banding ulcers heal.
- A defined plan for repeat banding sessions and surveillance gastroscopies.
- Coordination with the wider team managing your liver condition and vein-pressure medicines.
- A named contact or unit number for problems at home, day or night.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The endoscopist's fee and the endoscopy unit or hospital facility fee
- Whether sedation or an anaesthetist is needed, and the level of monitoring
- The number of banding sessions required to obliterate the varices
- Any inpatient stay, especially for an emergency bleed
- Acid-reducing and vein-pressure medicines
- Follow-up surveillance gastroscopies
- Management of the underlying liver condition, charged separately
- The endoscopist's fee and the unit or hospital facility fee
- Sedation or anaesthetist costs and the level of monitoring
- How many banding sessions are expected and whether each is charged separately
- Whether follow-up gastroscopies are included
- Whether medicines are included or prescribed separately
- What happens, and who is responsible, if a complication such as bleeding occurs
- The cancellation and rebooking policy
On the NHS? Banding of oesophageal varices is carried out on the NHS, including as an emergency for a bleeding varix; planned banding may also be done privately, but a variceal bleed is a hospital emergency.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that banding treats the varices but not the underlying liver disease, so varices can recur.
- Not warning clearly about bleeding from banding ulcers in the first one to two weeks, and what to do.
- Not discussing sedation and the 24-hour driving and escort rules for planned procedures.
- Not explaining that several sessions and follow-up gastroscopies are usually needed.
- No clear emergency contact and warning-sign advice for a bleed at home.
Marketing red flags
- Describing banding as a one-off 'fix' rather than part of ongoing liver care.
- Not mentioning the need for repeat sessions, medicines and surveillance.
- Downplaying the risk of bleeding from banding ulcers afterwards.
- Offering planned banding without a clear plan for managing the underlying liver disease.
- No clear arrangement for handling an emergency bleed.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Why am I having banding — to stop a bleed, or to prevent one?
- How many sessions am I likely to need, and how far apart?
- Should I also take medicines to lower the pressure in my veins?
- What acid-reducing medicine and diet should I follow afterwards to help healing?
- Exactly what should I do, and who should I contact, if I vomit blood or pass black stools?
- How is my underlying liver condition being managed alongside the banding?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Why do I have varices in the first place?
Does banding hurt?
Will one session be enough?
What are the main risks?
What should I eat afterwards?
Is this done on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Cambridge University Hospitals — Gastroscopy with oesophageal variceal banding or injection Doncaster and Bassetlaw NHS — Banding of oesophageal varices (patient leaflet) Cochrane review — Band ligation for primary prevention of variceal bleeding in cirrhosis (PMC) Oesophageal variceal ligation for acute variceal bleeding: efficacy and safety (PMC) British Society of Gastroenterology — clinical resources
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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